X9C-21572-55696
2 vaccinations
1 coded response
10 check-ins
1 free-text entry
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 837 / ID
- Registered
- 2021-01-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Registered in v-safe
-
2021-01-11
Dose 1 — Moderna
- 2021-01-11
- 2021-01-12
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
-
2021-02-08
Dose 2 — Moderna
- 2021-08-09
-
2022-02-08
Survey response — 12 months, dose 2MedDRA: COVID-19 — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I got covid 1/3/22MedDRA releases: 2024-11 · check-in free text available
-
2022-02-08
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-02-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-08 | Successful 2022-02-10 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 11 — 12 months, dose 2
Symptoms: I got covid 1/3/22
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | COVID-19 | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release